Guidance to protect workers from Varicella Zoster Virus (VZV), commonly known as chicken pox or shingles, has been published by the Royal College of Physicians’ Health and Work Development Unit, funded by NHS Plus, and includes a section aimed specifically at employers. The updated guideline extends previous recommendations with regard to pregnant women and people whose immune systems are compromised.
The purpose of the guidance is to offer evidence-based advice on the management of VZV in the workplace, and is intended to be used by employers, employees and occupational health (OH) professionals. The recommendations cover immunisation against chicken pox, management of employees with chicken pox or shingles and the prevention of transmission of these infections to colleagues or patients.
While chickenpox vaccination and antibody testing are not routinely recommended for workers in employment sectors outside healthcare, managers in other employment sectors often seek guidance when a staff member develops the illness. The guideline development group have made several recommendations to protect the general workforce from chicken pox which include:
- Workers diagnosed with chickenpox should remain away from the workplace until there are no new lesions and all lesions have crusted over.
- A worker with a localised shingles rash on a part of the body that can be covered with a bandage and/or clothing should be allowed to work if they feel well.
- However, workers with widespread shingles or a localised shingles rash that cannot be covered (eg facial), and those whose who have compromised immune systems should remain away from the workplace until the lesions have crusted over.
- Employers should ask pregnant or immuno-suppressed workers who have been exposed to an infected colleague at work to contact their GP or relevant specialist immediately for advice.
Workers in healthcare settings and prisons or immigration centres, who are at risk of exposure to chicken pox or shingles, should be offered a vaccination as it has been shown to be effective in providing adults with long-term protection from a potentially serious VZV disease. In healthcare, if a vaccine is declined, the reasons should be explored and the benefits of vaccination and the individual’s professional duty to protect their patients from infection should be explained.
Other recommendations for healthcare settings include:
- Healthcare workers diagnosed with chickenpox should be excluded from the workplace until there are no new lesions and all lesions have crusted over.
- Susceptible healthcare workers who have a significant exposure to VZV should either be excluded from contact with high-risk patients or inform their occupational health department if they feel unwell or develop a rash or fever during the incubation period.
- Decisions about restrictions should be taken in conjunction with the healthcare worker, their manager and infection control, while respecting the worker’s right to medical confidentiality.
- Pregnant healthcare workers exposed to chickenpox or shingles should be assessed by an OH or other appropriate health professional.
Leader of the Guideline Development Group, Dr Jacques SinFat Tamin, commented:
Significant changes in the understanding of the implications of VZV in the workplace make this guideline a valuable update to existing guidance. Specifically, the focus on the extra attention that should be given to pregnant women and those who have compromised immune systems goes further than the existing Green Book and should be particularly helpful for employers.
Dr Sian Williams, clinical director of the RCP’s Health and Work Development Unit, added:
Chickenpox is highly infectious and while normally a mild illness, some individuals may experience serious complications. Excluding individuals with chickenpox from the workplace until they are no longer contagious, and ensuring other procedures to reduce transmission are followed, protects healthcare workers and their patients, and colleagues.
Dr Charlie Vivian, director of quality at NHS Plus, added:
While the risk of transmission of chicken pox or shingles may be lower in non-healthcare settings, there are certain groups, such as pregnant women and those who are immuno-compromised, for whom VZV is especially dangerous.
This new guidance for all employers outlines procedures that will protect everyone and reduce the spread of any outbreaks.